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Grand Challenges is a family of initiatives fostering innovation to solve key global health and development problems. Each initiative is an experiment in the use of challenges to focus innovation on making an impact. Individual challenges address some of the same problems, but from differing perspectives.

Bill Thies and the team of 99DOTS aim to achieve 99% TB drug adherence using a combination of basic mobile phones and augmented blister packaging to provide real-time medication monitoring at drastically reduced cost. The approach is to utilize a custom envelope, or blister card, into which each pack of medication is inserted and sealed by the care provider. When the patient dispenses medication from the blister pack, the pills also break through perforated flaps on the blister card. On the back side of each flap is a hidden number. Patients submit these numbers using their mobile phone as evidence that they have dispensed medication. To avoid incurring any mobile charges, the numbers are used to complete a phone number and deliver a "Missed call" (Missed calls are free if they are not pointed to a VoiceMail). Using this system patients also receive a series of daily reminders (via SMS and automated calls). Missed doses trigger SMS notifications to care providers, who follow up with personal, phone-based counseling. Real-time adherence reports are also made available on the web.

Shashank Garg and team will develop a mobile solution that addresses problems in adherence to TB treatment through the key technologies of mobile phone-based electronic forms, workflow management, identity management, and electronic health records. The objective is to achieve automated tracking and monitoring of individual TB patients for adherence to the TB treatment protocol. ASHA workers will use the mobile application for collection of dosage intake data in the field. A workflow system will provide a closed loop through SMS alerts in case a patient defaults. Along with identity management and a TB treatment record, the system will ensure patients are able to seek treatment even on migration, thus maintaining continuity of treatment. This mobile solution is novel because it will use a form-based mobile application capable of running in disconnected or offline mode, with data connectivity being required only for the duration of data upload to the server.

Debjani Paul, Ninad Mehendale and Ammar Jagirdar from the Indian Institute of Technology Bombay in India will develop a simple system to detect sickle cell disease for use by untrained individuals in tribal populations in India in order to reduce infant mortality rates. Current diagnostics require expensive equipment and trained personnel, and are often inaccessible to the rural populations most in need. They will produce a microfluidic chip that can preserve a sample of blood in the deoxygenated environment required to maintain its characteristic sickle-shape, which can then be detected by a modified mobile phone camera and automated software that they will also develop. The system will be tested for sensitivity and specificity using blood from patients with sickle cell disease. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

Sanjiban Banerjee and Sambuddha Ghosh at AbGenics LifeSciences Pvt. Ltd in India will develop a new method to treat intestinal worm (helminth) infections using modified probiotic strains of the bacterium Lactobacillus. Lactobacillus, which can live in the human gut, will be modified to produce stable RNA molecules selected to target specific helminth genes and ultimately destroy the parasite, thereby curing the infection. Because Lactobacillus colonizes the gut, it can be used as a long-term treatment for multiple helminth infections. Efficacy of the approach will be tested in hamster and rabbit models of intestinal worm infections. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

Manjari Deb and team are developing a small, electronic pill dispenser called the CoxBox that enables real-time tracking of patient treatment adherence and inventory. The CoxBox innovation provides a relatively inexpensive and easily implementable solution for action-oriented monitoring and controlling of anti-tubercular drug adherence through the use of a microcontroller-based electromechanical pill box with programmable alarm annunciator and a built-in mobile device.

Lazar Mathew and team are working on a smart pill box that tracks exactly the time through radio frequency identification (RFID) of the dose coupled with SMS trigger systems. The pill box can dispense blister packs rather than tablets, and incorporates a timer which can only be programmed by the medicine provider. Medication cannot be taken out before or after certain times, preventing double dosage. SMS reminders will be sent to family members as well. Monitoring of up to 90 dosages will be possible with a table-top dispenser.

Kouichi Hasegawa of the Institute for Stem Cell Biology and Regenerative Medicine in India will develop an assay using human liver cells to study the parasite Plasmodium vivax, which causes malaria, and to screen for new anti-malarial drugs. During the parasitic life cycle inside human hosts, P. vivax infects hepatocytes (liver cells), where it can lie dormant and protected from treatment, leading to disease relapse. To identify new drugs to target this stage of P. vivax requires large numbers of human liver cells, which are difficult to obtain and often unsuitable. A new approach will be used to generate human hepatocytes by isolating a type of white blood cell from individuals infected with P. vivax, and inducing them to differentiate into hepatocytes, which should better support parasite growth. Once validated, this P. vivax liver-stage culture system will be used in a preliminary screen of a set of chemical compounds to identify new anti-malarial drugs. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

Kanury Rao of International Centre for Genetic Engineering and Biotechnology in India is testing small molecule inhibitors of host proteins required for M. tuberculosis to survive and replicate within host cells. Identifying and optimizing compounds that target host proteins could lead to new drug therapies for tuberculosis that are effective even against multidrug-resistant bacterial strains. This grant was selected through India's IKP Knowledge Park and their IKP-GCE program.

In this ICT-based pilot project, Digital Education, tested the impact of a combination of ICT and Participatory Learning Action (PLA) approaches to improve women's knowledge of nutrition in 30 villages. They promoted the dissemination of a series of nutrition-specific participatory videos to address nutrition-specific behaviors, locally feasible solutions as well as expenditure patterns to improve maternal and child diet quality.

This project aims to utilize ultrasound to move and settle human waste collected in a specifically designed latrine. This redesigned latrine uses less water and therefore provides a more sustainable solution to collect human waste.

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